GANAWENDAASOWIN PROGRAMS YOUTH SUICIDE PREVENTION AND INTERVENTION HANDBOOK

Transcription

1 GANAWENDAASOWIN PROGRAMS YOUTH SUICIDE PREVENTION AND INTERVENTION HANDBOOK Weechi-it-te-win family services Inc. Draft Yuth Suicide Preventin and Interventin Handbk WEECHI-IT-TE-WIN FAMILY SERVICES GANAWENDAASOWIN ASSESSMENT PROGRAM & GANAWENDAASOWIN TREATMENT PROGRAM P.O. Bx 812 Frt Frances, Ontari P9A 3N1 Phne Fax

2 Intrductin Yuth Suicide The likelihd f residents r staff encuntering a suicidal resident is real. Few events are mre painful r ptentially disruptive than the suicide f a lved ne. Suicide is an issue fr peple frm all educatinal and sciecnmic backgrunds. Cntrary t ppular belief, talking abut suicide r asking smene if they are feeling suicidal will NOT put the idea in their head r cause them t kill themselves. There is evidence that suicide is preventable in many cases. Apprpriate and timely crisis interventin helps Ganawendaaswin Staff Persnnel t maintain cntrl in a crisis and may help prevent cpycat behavir. The Imprtance f Suicide Preventin Handbk The Weechi-it-te-win Ganawendaaswin Prgrams are seeking guidance in the develpment f cmprehensive suicide preventin and interventin prtcl t assist their staff persnnel in respnding t suicidal behavir. Abut these Guidelines This dcument recgnizes and builds n the skills and resurces inherent in a residential Yuth Treatment Centre. Yuth Treatment Centers' are exceptinally resilient and resurceful. Staff members may be called upn t deal with crises n any given day. GAP / GTP Staff can prvide a surce f supprt and stability fr residents within the facility. These suicide preventin and interventin hand bk is designed fr GAP / GTP t use within existing prtcls t assist at-risk residents and intervene apprpriately in a suicide related crisis. The GAP / GTP Staff may chse t implement additinal supprtive measures t fit the specific needs f an individual with the directin f the Team Leader. THE INTENT OF THIS DOCUMENT IS TO HELP THE GANAWENDAASOWIN ASSESSMENT PROGRAM HOME AND GANAWENDAASOWIN TREATMENT PROGRAM HOME: Understand the nature f yuth suicide: the myths and facts; risk and prtective factrs; warning signs and clues; and apprpriate interventin steps. Establish residential yuth treatment based prtcls fr suicide preventin, crisis interventin. Build Cnnectins within a cmmunity and amng reginal supprt services. Educate Ganawendaaswin staff persnnel, parents, and residents abut effective suicide preventin and interventin.

3 Ratinale fr Develping and Implementing the Yuth Suicide Preventin and interventin Handbk A. Suicide is the secnd leading cause f death fr yuth aged and the third leading cause f death fr yuth aged Of every 5 yuth suicides, 4 are males. B. Suicide is an issue f cncern t GAP / GTP Staff persnnel and many yuth and families within the Treaty #3 Area. C. Given the strng crrelatin between suicidal and vilent behavir, preparatin fr respnding t suicide crises may prvide a framewrk t aid GAP / GTP staff persnnel in respnding t the threat f interpersnal vilence amng residents. D Advanced planning is critical t prviding an effective crisis respnse. Internal and external resurces must be in place t address clients' issues and t nrmalize, as much as pssible in a crisis, the learning envirnment fr everyne. E. All GAP / GTP staff persnnel need t knw that prtcls exist t refer at-risk clients t trained prfessinals s that the burden f respnsibility des nt rest slely with the individual "n the scene." While mst GAP / GTP staff persnnel qualified and expected t prvide the in-depth assessment r cunseling necessary fr treating a suicidal client, they are respnsible fr taking reasnable and prudent actins t help at-risk clients, such as ntifying parents/guardians, agencies, making apprpriate referrals and securing utside assistance when needed. G. GAP / GTP staff persnnel, parents/guardians, agencies, and clients need t be cnfident that help is available if/when they raise cncerns regarding suicidal behavir. Studies shw that clients ften knw, but d nt tell adults, abut a suicidal peer because they d nt knw hw adults will respnd r think they can t help. H. Special issues such as cpycat behavir, misinfrmatin, rumrs and hysteria must be cnsidered when respnding t suicidal behavir.

4 Cmpnents f Yuth Suicide Preventin These yuth suicide preventin cmpnents are recmmended fr implementatin at the GAP/GTP t aid staff persnnel in identifying and assisting clients at-risk f suicide: Preventin and interventin prtcls guide GAP / GTP staff persnnel in respnding effectively t suicidal behavir in trubled clients, in thse wh threaten r attempt suicide, and in thers atrisk in the aftermath f a death by suicide. Prtcls clarify fr GAP / GTP staff persnnel their rle in suicide preventin and crisis interventin and lessen the burden n individual GAP/GTP emplyees. An agreement with service prviders that utline preventin and crisis interventin services t be prvided t the GAP/GTP including: 1. Accepting client referrals and cnducting client risk assessments. 2. Educating the clients abut yuth suicide preventin. 3. Assisting staff with respnse in a crisis. 4. Debriefing with Treatment team members and ther staff. Designated GAP/GTP staff persnnel specifically trained in suicide preventin and available t screen, intervene, and refer a suicidal yuth. GAP/GTP Staff shuld be knwledgeable n: 1. The Suicide Risk Assessment and hw t cmplete it. 2. Suicide preventin infrmatin and resurce materials fr parents including: a. Suicide warning signs and risk factrs; b. Available resurces t assist trubled yuth; and c. Hw t supprt grieving yuth after the suicide f a friend r family members 3. Suicide preventin educatin fr clients includes: a. Infrmatin n suicide risk factrs and warning signs. b. A strng fcus n building help seeking skills and reducing the barriers that impede turning t an adult fr help, c. An accurate and current list f resurces where clients can find help bth within and utside the GAP / GTP. 4. A range f respnsive supprt services fr at-risk clients nce they leave GAP / GTP including: a. Grups where they can learn and practice life skills. b. Substance abuse preventin and ther specialized services.

5 The GAP / GTP is an envirnment that prmtes safety and respect fr all clients and persnnel including: Yuth Suicide 1. Cnsistently enfrced disciplinary, harassment plicies. 2. Prcedures t supprt the persnal safety f clients and staff 3. Knwledgeable, infrmed and caring staff. 4. Staff develpment training and client educatin in prtecting and respecting thers. 5. Clean and safe buildings and grunds. 6. Opprtunities t share decisin making in relevant matters. 7. An envirnment that encurages parent invlvement in ways that benefit clients. 8. Respect fr diversity. 9. Recgnitin f all clients' achievements and cntributins. 10. Cnnecting clients with a Bi-Cultural Clinician The likelihd f residents r staff encuntering a suicidal resident is real. Few events are mre painful r ptentially disruptive than the suicide f a peer resident. Suicide is an issue fr peple frm all educatinal and sciecnmic backgrunds. Cntrary t ppular belief, talking abut suicide r asking smene if they are feeling suicidal will NOT put the idea in their head r cause them t kill themselves. There is evidence that suicide is preventable in many cases. Apprpriate and timely crisis interventin helps Ganawendaaswin Staff Persnnel t maintain cntrl in a crisis and may help prevent cpycat behavir. The Weechi-it-te-win Ganawendaaswin Prgrams is seeking guidance in the develpment f cmprehensive suicide preventin and interventin prtcl t assist their staff persnnel in respnding t suicidal behavir. Abut these Prtcls This dcument recgnizes and builds n the skills and resurces inherent in a residential yuth treatment centre. Yuth Treatment Centers' are exceptinally resilient and resurceful whse staff members may be called upn t deal with crises n any given day. GTP & GAP Staff can prvide a surce f supprt and stability fr residents within the facility. These suicide preventin and interventin prtcls are designed fr GTP & GAP t use within existing prtcls t assist at-risk residents and intervene apprpriately in a suicide related crisis. The Executive Directr and Directr f Residential Prgrams and Services and GTP & GAP persnnel may chse t implement additinal supprtive measures t fit the specific needs f an individual. The purpse f these prtcls is t assist the GTP & GAP in their planning. The prtcls d nt cnstitute legal advice, nr are they intended t d s.

6 The Imprtance f Suicide Preventin Prtcl THE INTENT OF THIS DOCUMENT IS TO HELP GANAWENDAASOWIN PROGRAM STAFF: Understand the nature f yuth suicide: the myths and facts; risk and prtective factrs; warning signs and clues; and apprpriate interventin steps. Establish residential yuth treatment based prtcls fr suicide preventin, crisis interventin. Build Cnnectins within a cmmunity and amng reginal supprt services. Educate GANAWENDAASOWIN staff persnnel, parents, and residents abut effective suicide preventin and interventin. Ratinale fr Develping and Implementing Yuth Suicide Preventin and interventin Prtcls: Suicide is the secnd leading cause f death fr yuth aged and the third leading cause f death fr yuth aged Of every 5 yuth suicides, 4 are males. Suicide is an issue f cncern t GTP & GAP Staff persnnel and many yuth and families within the Treaty #3 Area. Given the strng crrelatin between suicidal and vilent behavir, preparatin fr respnding t suicide crises may prvide a framewrk t aid GTP & GAP staff persnnel in respnding t the threat f interpersnal vilence amng residents. Advanced planning is critical t prviding an effective crisis respnse. Internal and external resurces must be in place t address clients' issues and t nrmalize, as much as pssible in a crisis, the learning envirnment fr everyne. All GTP & GAP staff persnnel need t knw that prtcls exist t refer at-risk clients t trained prfessinals s that the burden f respnsibility des nt rest slely with the individual "n the scene." While mst GTP & GAP staff persnnel qualified and expected t prvide the in-depth assessment r cunseling necessary fr treating a suicidal client, they are respnsible fr taking reasnable and prudent actins t help at-risk clients, such as ntifying parents/guardians, agencies, making apprpriate referrals and securing utside assistance when needed. GTP & GAP staff persnnel, parents/guardians, agencies, and clients need t be cnfident that help is available if/when they raise cncerns regarding suicidal behavir. Studies shw that clients ften knw, but d nt tell adults, abut a suicidal peer because they d nt knw hw adults will respnd r think they can't help. Special issues such as cpycat behavir, misinfrmatin, rumrs and hysteria must be cnsidered when respnding t suicidal behavir.

7 Cmpnents f Yuth Suicide Preventin These yuth suicide preventin cmpnents are recmmended fr implementatin at the GTP & GAP t aid staff persnnel in identifying and assisting clients at-risk f suicide: Preventin and interventin prtcls guide GTP & GAP staff persnnel in respnding effectively t suicidal behavir in trubled clients, in thse wh threaten r attempt suicide, and in thers at-risk in the aftermath f a death by suicide. Prtcls clarify fr GTP & GAP staff persnnel their rle in suicide preventin and crisis interventin and lessen the burden n individual GTP & GAP emplyees. An agreement with service prviders that utline preventin and crisis interventin services t be prvided t the GTP & GAP including: 1. Accepting client referrals and cnducting client risk assessments. 2. Educating the clients abut yuth suicide preventin. 3. Assisting GTP & GAP staff with respnse in a crisis. 4. Debriefing with GTP & GAP Treatment team members and ther staff. Designated GTP & GAP staff persnnel specifically trained in suicide preventin and available t screen, intervene, and refer a suicidal yuth. GTP & GAP Staff shuld be knwledgeable abut suicide preventin 1. ALL GTP & GAP persnnel ther supprt staff/ relief receive a basic suicide preventin infrmatin awareness sessin that includes: A basic 3-step interventin t help suicidal yuth; Accurate and current infrmatin abut, cmmunity resurces fr help; Self-care guidelines fr staff that wrk with a suicidal yuth; and An understanding f the GTP & GAP suicide preventin prtcls. 2. Suicide preventin infrmatin and resurce materials fr parents including: Suicide warning signs and risk factrs; Available resurces t assist trubled yuth; and Hw t supprt grieving yuth after the suicide f a friend r family member. 3. Suicide preventin educatin fr students, within cmprehensive health educatin, ffered by staff trained in suicide preventin curriculum. Student educatin shuld nly be dne after the prtcls are established and GTP & GAP persnnel are educated 4. Suicide preventin educatin fr clients includes: Infrmatin n suicide risk factrs and warning signs. A strng fcus n building help seeking skills and reducing the barriers that impede turning t an adult fr help, An accurate and current list f resurces where clients can find help bth within and utside the GTP & GAP.

8 6. A range f respnsive supprt services fr at-risk clients including: Grups where they can learn and practice life skills. Substance abuse preventin and ther specialized services. The GTP & GAP is a climate that prmtes safety and respect fr all clients and GTP & GAP persnnel including: Cnsistently enfrced disciplinary, harassment plicies. Prcedures t supprt the persnal safety f clients and staff Knwledgeable, infrmed and caring staff. Staff develpment training and client educatin in prtecting and respecting thers. Clean and safe buildings and grunds. Opprtunities t share decisin making in relevant matters. An envirnment that encurages parent invlvement in ways that benefit clients and GTP & GAP staff persnnel. Respect fr diversity. Recgnitin f all clients' achievements and cntributins. Cnnecting clients with a caring Staff thrugh an advisr/advisee system. Cmpnents f GTP & GAP Based Suicide Interventin Suicide Interventin Prtcls within the GTP & GAP GTP & GAP is required t develp "crisis respnse plans t deal with crisis and ptential crisis situatins invlving vilent acts by r against clients/ staff. Prtcls t effectively assist clients in a crisis invlving suicidal behavir are a critical cmpnent f GTP & GAP crisis respnse plans. Crisis respnse plans wrk best when the GTP & GAP Team Leaders invlves staff in their develpment. The prtcls aid GTP & GAP staff persnnel in intervening effectively with suicidal clients. Managers play a crucial rle in establishing a climate that requires all GTP & GAP staff persnnel t be familiar with and respnsive t suicide crisis interventin prtcls in rder t help prevent a yuth suicide. New GTP & GAP staff persnnel must be prvided basic suicide awareness educatin training and infrmed abut the GTP & GAP prtcls. Gals f a Suicide Interventin Plan 1. Outline specific actins t be implemented in respnse t suicidal behavir. 2. Clearly designate specific individuals and alternates in each building t respnd t a variety f crisis situatins. It is especially imprtant that persnnel and client knw whm t cntact if a client demnstrates any signs f suicidal behavir. It is imprtant t make sure that the cntact list is updated regularly. A. Ganawendaaswin Team Leader/ designate, Weechi-it-te-win On-Call Wrker 3. Identify pre-arranged cntacts, referral resurces and prcedures with lcal crisis service persnnel, plice and emergency medical service prviders s that these necessary services are readily accessible in a crisis. 4. Establish dcumentatin prcedures and frms. 5. Outline fllw-up steps fr persnnel t take after an interventin with clients.

9 Guidelines Fr When The Risk Of Suicide Has Been Raised The risk f suicide is raised when any peer r ther GTP & GAP emplyee identifies smene as ptentially suicidal because s/he has directly r indirectly expressed suicidal thughts (ideatin) r demnstrated ther clues r warning signs. 1. Take the threat f self-harm seriusly. 2. Take immediate actin. Cntact the GTP & GAP Team Leader r designate t infrm him/her f the situatin. 3. A Staff persnnel is t remain clse t the client talks with him/her in a quiet, private setting t clarify the situatin and prvide apprpriate supprt. 4. The Bi-Cultural Clinician trained in suicide preventin is cntacted t meet with the client and des a basic screening that includes specific inquiry as t the existence f a suicide plan. The Bi-Cultural Clinician may cnsult with the Treatment Team and ask that the yuth be seen by a Dctr fr a pssible 72 hr psychiatric evaluatin. 5. Parents must always be ntified when there appears t be any risk f self-harm, unless it is apparent that such ntificatin will exacerbate the situatin. The individual wh ntifies the parent shuld be the Case Manager r Shift Leader r ther persn wh has the experience/expertise and/r a special relatinship with the client. Resurce infrmatin shuld be prvided if needed. The same persn shuld fllw-up with the parents within a few days t determine what has been dne and the next steps. 6. When a Ganawendaaswin Staff member knws, r has reasnable cause t suspect, that a client has been r is likely t be abused r neglected, he/ she must make a reprt f suspected abuse r neglect t the Investigatin and Assessment. Any ther GTP & GAP persnnel are t infrm the Team Leader f suspected abuse s that the Team Leader can make the reprt r delegate the staff member wh has reprted the abuse t reprt it immediately. All Staff are all mandated reprters fr suspected child abuse and neglect. 8. Dcument actins taken as required by GTP & GAP prtcl are imperative. Guidelines fr Medium t High Risk Situatins Medium t high risk exists when a staff persn bserves a resident is making explicit statements indicating the wish r threat t die, has access t r is in pssessin f lethal means, wh appears significantly depressed, mdy, irritable, unable t cncentrate r withdrawn. 1. All staff members understand that they must take suicidal behavir seriusly every time. 2. The staff persn "n the scene" takes immediate actin t infrm the Team Leader t respnd t such situatins. 3. The staff member talks with the client, staying calm and listening attentively. It is crucial t keep the client under cntinuus adult supervisin until the designated trained staff persn arrives. 4. The Bi-Cultural Clinician cnducts a suicide risk assessment with the client t determine he lethality f the threat. This includes: a. Determining if the client has a plan. b. Asking if the client has lethal means n their pssessin r accessible elsewhere, c. Cnsulting with a referring agent if necessary t btain an assessment f the client's mental state and a recmmendatin fr treatment.

10 5. If the client is in pssessin f lethal means, secure the area and prevent ther students frm accessing this area. Lethal means must be remved withut putting anyne in danger. The Team Leader r Case Manager (r designate) cntacts the wrker, parents r guardians t: a. Ntify them f the situatin. b. Prvide them with a full reprt. c. Discuss and advise them n steps t be taken. Release the client t the parents/guardians with referrals and resurces (names and phne numbers), d. Infrm the parents/guardians that yu will fllw-up with them n actins taken. NO CLIENT IN THIS SITUATION SHOULD BE LEFT ALONE! In the event that the situatin requires transprtatin t a hspital emergency department, crisis services and/r law enfrcement shuld be cntacted t assess the situatin and expedite the transitin t the hspital. Dcument actins taken as required by GTP & GAP prtcl are imperative. Debrief with all staff members wh assisted with the interventin. Guidelines fr When the Threat Invlves a Suicide Pact A suicide pact is when tw r mre individuals agree t kill themselves at the same time and place, r agree that if ne dies, the thers will sn fllw. Suicide pacts are very rare, extremely dangerus and must be taken seriusly whenever rumred r threatened. Cmmn characteristics f pacts include: Suicide pacts are likely t invlve unhappy lvers, clse friends suffering frm depressin r individuals feeling misunderstd r maltreated by thers. It is nt uncmmn fr thse invlved in a suicide pact t be using drugs and having serius prblems at hme. Usually there is a "leader" wh clearly dminates the ther(s) putting ne r mre individuals in danger. It is imprtant t identify him/her as sn as pssible. Often the parties invlved have been swrn t secrecy and are reluctant t disclse infrmatin ut f fear and lyalty. 1. Fllw all the steps in the previus sectin expanded t identify all f the individuals invlved in the pact and thse wh knw abut it. Fllw-up with all f thse invlved and their parent/guardians is vitally imprtant. 2. In an attempt t keep the behavir frm escalating, nging cmmunicatin between GTP & GAP staff persnnel, parents/guardians, and the individual clients invlved in planning the pact is necessary. 3. Guidelines Fr Respnding t a Client Suicide Attempt n the GTP & GAP Premises When a client exhibits life-threatening behavir r has cmmitted an act f deliberate self-harm n the premises, an immediate respnse is necessary. Actins

11 required f the staff persn n the scene as well as thse f the GTP & GAP Team Leaders r designate must be carefully planned in advance. Prcedures fr Assisting the Suicidal Client: 1. Keep the client safe and under clse supervisin. Never leave the client alne. Designate ne r mre staff members t stay with and supprt the individual in crisis while help is being sught. 2. Ntify the GTP & GAP Team Leader r designate wh will immediately cmmunicate with designated individuals such as Treatment Team members. 3. Ntify the parents/guardians f what has ccurred and arrange t meet them wherever apprpriate. 4. Cnsult with Bi-Cultural Therapists as necessary t assess the client's mental state and t btain a recmmendatin fr needed treatment. Helping Suicidal Yuth What is NOT Helpful When Wrking with Smene Wh Might Be Suicidal? Ignring r dismissing the issue. This sends the message that yu dn't hear their message, dn't believe them, r yu dn't care abut their pain. Acting shcked r embarrassed. Panicking, preaching, r patrnizing. Challenging, debating, r bargaining. Never challenge a suicidal persn. Yu can't win in a pwer struggle with smene wh is thinking irratinally. Giving harmful advice... such as suggesting the use f drugs r alchl t "feel better." There is a very strng assciatin between alchl use and suicide. Prmising t keep a secret. The suicidal persn is sharing his/her feelings hping that smene will recgnize the pain and help, even thugh they may verbally cntradict this. What is helpful?? 1. Shw yu care - Listen carefully - Be genuine. "I'm cncerned abut yu...abut hw yu feel." 2. Ask the questin - Be direct, caring and nn-cnfrntatinal. "Are yu thinking abut suicide?" 3. Get Help - D nt leave him/her alne. "Yu are nt alne. I will help yu get the help yu need." Resurces fr Help It is necessary t maintain lists f resurces available fr use by GTP & GAP Staff persnnel s that they knw exactly wh t cntact when they are wrking with a client wh might be suicidal. The fllwing is a list with lcal cntact infrmatin. This is update n regular basis. Cmmunity Resurces Crisis Line Mental Health Agencies, especially yuth service Private Clinics/facilities Hspital emergency rms Plice Lcal Religius Leaders Emergency Medical Services Take Care f Yu, Wrking with Suicidal Peple is challenging. Acknwledge the intensity f yur feelings. Seek supprt.

12 Avid ver- invlvement. It takes a team f peple t help a suicidal individual. Never d this wrk n yur wn. Always infrm yur Shift Leader and Team Leader as utlined in GANAWENDAASOWIN prtcl. Recgnize that yu are nt respnsible fr anther persn's chice t end his/her life. Nrmal Reactins t Overwhelming Stressful Events Mst peple have reactins t traumatic events r ther verwhelming situatins. These experiences may affect yur ability t functin and take care f yurself. Everyne reacts differently, based n persnal experiences. Smetimes it appears that there is n reactin at all, smetimes the reactin is immediate, and smetimes reactins are delayed. Cmmn reactins t a death, near death r verwhelming event are: Thughts: Re-enacting the event ver and ver in yur mind Physical Reactins: Fatigue Headaches Truble Cncentrating Emtinal Reactins: Feeling Stressed Feeling Anxius Feeling Overwhelmed Feeling Numb Irritability Nightmares Sadness Anger Apprehensin Changes in Behavirs: Increase in Risk-Taking Change in Appetite Sleep Prblems Increase in use f Alchl r Drugs Withdrawal

13 What can I d t feel better? Get invlved in activities that yu can start and finish in ne day. Eat healthy fds and get physical exercise. Talk penly with a friend r persn yu trust abut yur feelings. Spend time ding things yu enjy, even if it is hard. Supprt a friend - this is remarkably healing. Listen t music yu think is psitive. When d I need t get additinal help? If yu cntinue t have truble functining nrmally, weeks r mnths after the events. When yu have a friend wh has these reactins and is nt getting better. When yu have thughts f harming r killing yurself r smene else. If yu are feeling verwhelmed r ut f cntrl. When yu are nt taking care f yurself Where can I get help? Parent, Friend (wh is nt verwhelmed), r Relative: Others (wh wuld yu put in?): Life skills Crdinatr r Ck, Pastr r anther adult that are trusted, Cunseling Services: Cmmn Yuth Reactins t Suicide and Recmmended Respnses Everyne grieves differently. Persnal and family experiences with death, religius beliefs, cmmunity expsures and cultural traditins all play a rle. Belw are sme f the mre r less predictable adlescent reactins t a suicide and suggested respnses. Shck and Denial. At first there may be remarkably little respnse. The reality f the death has yet t be absrbed. "Yu are kidding, right?" "This is just a jke - it can't be true." Suggested Respnse: Acknwledge the shck, anticipate the reactin t cme, demnstrate a willingness t talk when students are ready. Anger and Prtectin. Generally speaking, "black and white" thinking sets in. Clients want smene t blame fr this and may penly express/direct anger at the deceased's parents/teachers/by/girlfriend. "Why did yu let this happen?" "It is yur entire fault that this happened!" Suggested Respnse: Listen and then listen sme mre. Gently explain that it is natural t want t find a reasn fr things we dn't understand. Suggest that suicide is a very cmplicated human behavir and that there are always multiple reasns and that blaming anther individual may put that persn at risk f suicide als. Guilt. Clients clse t the deceased may blame themselves. "If nly I had called him back last night;" "I shuld have knwn...i shuld nt have teased him... " Suggested Respnse: Remind clients that nly the persn wh kills him/herself is respnsible fr having made that decisin. Anger at the Deceased. This is surprisingly cmmn, amng clse friends as well as thse wh were nt clse t the deceased. "Hw culd she d smething s stupid?" Suggested Respnse:

14 Allwing and acknwledging sme expressin f anger is helpful. Explain that this is a nrmal stage f grieving. Acknwledgement f anger ften lessens its intensity. Anxiety. Clients smetimes start t wrry abut themselves and/r ther friends. "If she culd get upset enugh t kill herself, maybe the same thing will happen t me (r ne f my friends)." Suggested Respnse: Help students differentiate between themselves and the dead persn. Remind them that help is always available. Discuss ther ptins and resurces. Practice prblem slving. Lneliness. Thse clsest t the deceased may find it almst impssible t return t a nrmal rutine, and may even resent thse wh appear t be having fun. They may feel empty, lst, ttally discnnected. They may becme bsessed with keeping the memry f their friend alive. Suggested Respnse: Encurage students t help each ther mve frward in psitive ways. Ntice anyne wh seems t be islating frm thers and reach ut t them, ffering resurces t help with grieving prcess. Hpe and Relief. Once the reality f death has been accepted, and the acute pain f the lss subsides, clients find that life resumes a large degree f nrmalcy and they cme t understand that ver time, they feel much better. They can remember their friend withut extreme pain. Suggested Respnse: Simply remain pen t listening t client's feelings, especially n the anniversaries (tw weeks, mnths, years, etc.). Recgnize the imprtance f bth murning and remembering. Hw t Supprt Grieving Yuth Avid: Giving a lt f advice Arguing ver trivial matters Making mralistic statements abut the persn wh died Minimizing the lss Discuraging r time-limiting the grieving prcess Assigning new respnsibilities right away D: Learn abut the grief prcess Be abslutely genuine and truthful Demnstrate lve and respect by being attentive Encurage talking abut feelings and abut the deceased friend Listen, n matter what! Offer t attend the visitatin r funeral with a yuth Allw crying - perhaps lts f crying Expect laughter - a sign f happy memries Fllw the lead f the "survivr" with patience and kindness Offer pprtunities fr remembering; i.e., special events, birthdays Expect that yur presence may be imprtant, while talking may be limited ("Silence is Glden") Share sme f yur experience with lss, but keep the fcus n the persn yu are supprting Help t identify thers t talk t (i.e., minister, priest, elder r cunselr)

15 Understand that memrials can be very cmfrting (i.e., writing a pem, a sng, a letter, making a scrapbk, buying a buquet, writing a letter) Believe in healing and grwth Cmmn Parental Reactins t Hearing that Their Child is Suicidal Acute persnal shck and distress Ttally paralyzed by anxiety Very cnfused, puzzled, r in denial Embarrassed Blamed, stigmatized Angry, belligerent, threatening Cncerns f the GTP & GAP Staff Safety f the yuth Prfessinal respnsibilities Cncerns f the Parent/ guardians Maintain sme equilibrium What t d; where t turn fr help